Apply Now – Hr. Merchant Services

Apply Now

MERCHANT PRE-CHECK FORM

COMPANY INFORMATION

Contracting Company Name

Registration Number

DBA Name

Company Address

Address Line

City

State

Zip Code

Country

Company Email

Company Phone Number

Official owner / % owned

Country of incorporation

Address

Address Line 1

City

Name Of CEO

CEO Telephone

Citizenship Of CEO

Name Of Beneficial Owner

Address Of Beneficial Owner

Telephone

Citizenship of Beneficial Owner

Years in business

Merchant business type

Detailed description of products/services sold

Do you have license for this business?

URL(s) that will be used

Test User (login/password)

Current processor/acquirer

How long with current processor/acquirer?

Traffic (country ratio)

Min/Average/Max transaction value

Monthly processing volume

Desired processing/payment currencies

3D secure YES/NO

Yes

No

Recurring transactions YES/NO

Yes

No

PCI DSS Compliance

Transactional History

LAST MONTH

LAST 2 MONTH

LAST 3 MONTH

LAST 4 MONTH

LAST 5 MONTH

Sales Volume/ Currency

Number Of Transactions

Chargeback Volume/Currency

Number of chargebacks

Refunds Volume/Currency

Number Of Refunds

Transaction country to country ratio

Min/max transaction amount